View source for Osteopathic medicine in the United States

{{Osteopathic medicine}}
'''Osteopathic medicine''' is a branch of the [[medicine|medical]] [[profession]] '''in the United States''', with  [[Doctor_of_Osteopathic_Medicine#International_practice_rights|recognition outside the US]] in forty-seven countries, including most Canadian provinces.  

[[Frontier]] physician [[Andrew Taylor Still]] founded the profession as a radical rejection of the prevailing system of medical thought of the 19th century.  Still's techniques relied heavily on the [[Joint manipulation|manipulation of joints and bones]] to diagnose and treat illness, and he called his practices "[[osteopathy]]". By the middle of the 20th century, the profession had moved closer to mainstream [[medicine]], adopting modern [[public health]] and [[Biomedicine|biomedical]] principles.  American "osteopaths" became "osteopathic physicians", gradually achieving full practice rights as medical doctors in all 50 states, including serving in the US armed forces as physicians.<ref name = "Reform">{{cite pmid|8267703}}</ref> 

In the 21st century, the training of osteopathic physicians in the United States is very similar to that of their MD counterparts.<ref name = "Harrisons">Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. ''Chapter 10. Complementary and Alternative Medicine'' Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw Hill.</ref> Osteopathic physicians attend 4 years of [[Medical school in the United States|medical school]] followed by at least 3 years of [[Residency (medicine)|residency]]. They use all conventional methods of diagnosis and treatment. Though still trained in [[Osteopathic Manipulative Medicine|Osteopathic Manipulative Medicine (OMM)]]<ref>{{cite pmid|10575385}}</ref>, the modern derivative of Still's techniques<ref>[http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent ''Osteopathic medicine.''] Intelihealth.com. accessed Dec 2007.</ref>, a minority of osteopathic physicians use it in actual practice.<ref>{{cite pmid|9059002}}</ref> 

Osteopathic medicine is considered by some in the United States to be both a profession and a [[social movement]],<ref name="NYT">Zuger A. [http://query.nytimes.com/gst/fullpage.html?res=940DE3DB163FF934A25751C0A96E958260&sec=health&spon=&pagewanted=1 ''Scorned No More, Osteopathy Is on the Rise.''] New York Times. 17 Feb 1998.</ref><ref name = "Parallel">{{cite pmid|8027001}}</ref> especially for its historically greater emphasis on [[primary care]] and [[holistic health]]. However, any [[Comparison of MD and DO in the United States|distinction between the MD and the DO professions]] has eroded steadily; diminishing numbers of DO graduates enter primary care fields<ref>Lloyd, Janice. [http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm Doctor shortage looms as primary care loses its pull.]  USA Today.  18 Aug 2009. Accessed 08 Sept 2009.</ref>, fewer use OMM, holistic patient care models are increasingly taught at MD schools, and increasing numbers of DO graduates choose to train in [[Accreditation Council for Graduate Medical Education|non-osteopathic]] [[Residency (medicine)|residency]] programs.<ref name ="Shannon2" /><ref name = "faculty" /><ref name = "pmid19474536">{{cite pmid|19474536}}</ref>

Discussions about the future of osteopathic medicine frequently debate the [[utility]] of maintaining a separate, distinct pathway for educating physicians in the United States.<ref name = "pmid19474536">{{cite pmid|19474536}}</ref><ref name = "pmid19474535">{{cite pmid|19474535}}</ref>  Studies have repeatedly shown that many recent osteopathic medical graduates are either uninterested in or reluctant to embrace an identity distinct from their MD counterparts.<ref name =reluctant>"Bates, B et al.[http://www.jaoa.org/cgi/content/abstract/109/7/359 The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate"] Journal of the American Osteopathic Association.  Vol 109. No 7. July 2009. 359-369</ref>  The rapid expansion in the number and size of schools has raised questions as to the quality of education at some osteopathic medical schools.  Leaders within the osteopathic community have referred to the present situation as a crisis.<ref name ="Shannon2" /><ref name = "faculty" />  Other contentious topics have been [[for profit schools|for-profit]] medical education, which osteopathic accreditors permit,<ref name = "RVU" /> and the status of lesbian, gay, bisexual and transgender ([[LGBT]])  osteopathic physicians.<ref>Johnson, Brooke. [https://www.do-online.org/pdf/pub_do0508outnotloud.pdf Out but Not Loud: Even as acceptance grows, gay DOs, students remain wary.] The DO Magazine. May 2008.</ref><ref>Johnson, Brooke. [https://www.do-online.org/pdf/pub_do0508transgen.pdf Life in transition: Transgender DO provides safe haven for patients.]  The DO magazine. May 2008.</ref><ref>Miskowicz-Retz, Konrad C. [https://www.do-online.org/pdf/pub_do1008letters.pdf Federal, state and local laws protect DOs, students from discrimination].  The DO magazine. Oct 2009.</ref><ref>SF City Ordinance 061278 [http://sfgov.org/site/uploadedfiles/bdsupvrs/resolutions06/r0536-06.pdf Resolution urging Touro University College of Osteopathic Medicine to reconsider their directive to revoke the charter of the [[Touro University Gay-Straight Alliance]]].</ref>

==Nomenclature==

[[Physician]]s and surgeons who graduate from osteopathic medical schools are known as physicians or [[osteopathic medicine|osteopathic]] medical physicians and hold a [[professional doctorate]], the Doctor of Osteopathic Medicine ([[Doctor of osteopathic medicine|DO]]), in contrast to the more familiar degree, the [[Doctor of Medicine]], or MD.<ref name= "Visible">{{cite pmid|9107129}}</ref><ref>{{cite pmid|10693310}}</ref><ref>{{cite book |last=Oths |first=Kathryn S. |coauthors=Servando Z. Hinojosa.|title=Healing by Hand: Manual Medicine and Bonesetting in Global Perspective |origdate= |origyear= |url=http://books.google.com/?id=hMsKph2uQnsC&pg=PA68&lpg=PA68&dq=%E2%80%9Costeopathic+invisibility|year=2004 |publisher=Rowman Altamira |isbn=0759103933 |chapter=Divergences in the evolution of Osteopathy |pages=67–68}}</ref>  US osteopathic medical physicians may be licensed in 47 countries, although osteopathic curricula in other countries differ from those in the United States. Osteopathic practitioners educated outside the US are known as "osteopaths" and their scope of practice excludes usual medical therapies and relies more on [[osteopathic manipulative medicine]] and other [[alternative medicine|alternative medical modalities]].

==Demographics==
[[Image:EnteringPhysiciansByEducation2005.PNG|thumb|left|300px|Physicians entering US workforce by education, 2005<ref name="Cohen">Cohen, Jordan. [http://www.aamc.org/newsroom/reporter/april05/word.htm ''A Word from the President: "Filling the Workforce Gap."''] [[Association of American Medical Colleges|AAMC]] Reporter: April 2005.</ref>]]
From its inception, the osteopathic profession has been smaller than the older MD profession.<ref>{{cite pmid|16569724}}</ref> Currently, there are 25 accredited osteopathic [[medical schools]]<ref>{{cite web|url=http://www.aacom.org/people/colleges/Pages/default.aspx|title= Member Colleges |accessdate=2008-03-11|publisher=American Association of Colleges of Osteopathic Medicine}}</ref> offering education in 31 locations in the United States and 126 accredited US [[Medical Doctor|MD]] medical schools.<ref>{{cite web|url=http://www.aamc.org/medicalschools.htm|title=AAMC Medical Schools|accessdate=2006-12-13|publisher=Association of American Medical Colleges}}</ref>
* In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic medical schools.
* In 2002, there were 49,210 physicians from 19 osteopathic schools.
* Between 1980 and 2005, the number of osteopathic graduates per year increased over 250 percent from about 1,000 to 2,800. This number is expected to approach 5,000 by 2015.<ref>{{cite pmid|16936479}}</ref>
* In 2007, there were 25 colleges of osteopathic medicine in 31 locations.<ref>[http://www.aacom.org/people/colleges/Pages/schoolmap.aspx ''Geographic Map of Colleges of Osteopathic Medicine''.] AACOM.</ref> One in five medical students in the United States is enrolled in an osteopathic medical school.<ref name = "AOA">[http://www.osteopathic.org/pdf/about_the_aoa.pdf About the AOA.] American Osteopathic Association. Accessed March 2008.</ref>
* By 2020, the number of osteopathic physicians will grow to 95,400, say expert predictions, according to the [[American Medical Association]].<ref>Myrle Croasdale. [http://www.ama-assn.org/amednews/2003/06/16/prsa0616.htm ''Can-DO strategy: Osteopathic medicine survives, and thrives.''] American Medical News. 16 Jun 2003.</ref>
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[[Image:Osteopathic distribution US2.PNG|thumb|left|300px|Geographic distribution of osteopathic physicians as a percentage of all physicians, by state. Locations of osteopathic medical schools are shown in red.<ref name="AACOM report">[http://www.aacom.org/resources/bookstore/2006statrpt/Pages/default.aspx 2006 Annual Statistical Report on Osteopathic Medical Education] American Association of Colleges of Osteopathic Medicine. Feb 2007.</ref>
<br />
{{legend0|#E1F5FF|<3% }} 
{{legend0|#CEEFFF|3-5% }} 
{{legend0|#8AD9FF|5-10%  }}
{{legend0|#008BCE|10-15%  }}
{{legend0|#0070A6|15-25%  }}]]
Osteopathic physicians are unevenly distributed in the United States. The states with the highest concentration are [[Michigan]] and [[Oklahoma]] where osteopathic physicians comprise over 20% of the total physician workforce. The state with the greatest number of osteopathic physicians is [[Pennsylvania]], with 6,048 DO's in active practice in 2008.<ref name="osteopathic.org">[http://www.osteopathic.org/index.cfm?PageID=aoa_ompreport Osteopathic Medical Profession Report] American Osteopathic Association. August 2008.</ref> The states with the lowest [[concentration]]s of DO's are [[Louisiana]], [[Massachusetts]] and [[Vermont]] where only 1-2% of physicians have an osteopathic degree.<ref name="AACOM report"/> Public awareness of osteopathic medicine likewise varies widely in different regions.<br />{{further|[[Comparison of MD and DO in the United States#Demographics|Comparison of MD and DO (demographics)]]}}{{-}}

==Osteopathic principles==
[[Image:Medical School.jpg|thumb|A physician demonstrates an [[Osteopathic Manipulative Medicine|OMM]] technique to medical students at an osteopathic medical school.]]
In addition to the [[Hippocratic oath]], Osteopathic medical students take an oath to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:
#The body is a unit, and the [[person]] represents a combination of [[body]], [[mind]] and [[spirit]].
#The body is capable of [[homeostasis|self-regulation]], self-healing, and health maintenance.
#Structure and function are reciprocally interrelated.
#Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.<ref name = "Gevitz" />

===Significance===
There are different opinions on the significance of these principles. Some note that the osteopathic philosophy is akin to the tenets of [[holistic medicine]].<ref name = "Harvard">[http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent ''Osteopathic medicine.''] Intelihealth.com.</ref> They suggest that osteopathic philosophy is a kind of [[social movement]] within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the [[primary care]] physician within the health care system.<ref name="NYT"/><ref>''About Osteopathic Medicine.'' [[American Osteopathic Association.]] Accessed 30 Aug 2007. [http://www.osteopathic.org/index.cfm?PageID=ost_main]</ref> Others liken the [[American Osteopathic Association|American Osteopathic Association's]] emphasis of the core principles to professional [[indoctrination]], a process which glorifies osteopathic practices and beliefs while misrepresenting those of the MD community.<ref name = "Paradox">{{cite pmid|10547412}}</ref> Still others point out that there is nothing in the principles that would distinguish DO from MD training in any fundamental way. One study, published in the [[Journal of the American Osteopathic Association]] found a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles, and some would even endorse them generally as sound medical principles.<ref name = "Gevitz" />
{{further|[[Comparison of MD and DO in the United States#Cultural differences|MD & DO (cultural differences)]]}}

== History ==
=== A new movement within medicine ===
[[Image:Andrew Taylor Still 1914.jpg|thumb|upright|Andrew Taylor Still, founder Osteopathic medicine]]
[[Frontier]] physician [[Andrew Taylor Still]], [[Doctor of Medicine|MD]], [[DO]], founded the American School of Osteopathy (now the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine) in [[Kirksville, MO]], in 1892 as a radical protest against the turn-of-the-century medical system. A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease.<ref>Still AT. [http://www.interlinea.org/atstill/eBookPMPO_V2.0.pdf ''The Philosophy and Mechanical Principles of Osteopathy.''] Kansas City, Mo: Hudson-Kimberly Pub Co; 1902:9–20,185,210,270. Version 2.0. Inter Linea Web site. Accessed January 23, 2006.</ref> He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were [[arsenic]], [[caster oil]], [[whiskey]], and [[opium]]. In addition, unsanitary surgical practices often resulted in more deaths than cures.<ref name = "Hansen">{{cite pmid|16585374}}]</ref>
{{Quote box
|width = 25%
|align = left
|quote = "To find health should be the object of the doctor.<br/>Anyone can find disease."
|source = [[Andrew Taylor Still]], 1874 
}}
 
He intended his new system of medicine to be a reformation of the existing 19th century medical practices he knew and imagined that someday "rational medical therapy" would consist of manipulation of the musculoskeletal system, surgery, and very sparingly used [[drugs]]. He invented the name "osteopathy" by blending two Greek roots ''osteon-'' for bone and ''-pathos'' for suffering in order to communicate his [[theory]] that [[disease]] and physiologic dysfunction were [[Etiology|etiologically]] grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.

[[Image:Twain1909.jpg|thumb|upright|left|Mark Twain was a vocal supporter of the early osteopathic movement.]]The new profession faced stiff opposition from the medical establishment at the time. The relationship of the osteopathic and medical professions was often "bitterly contentious"<ref name="Cohen">Cohen, Jordan. ''A Word from the President: "Filling the Workforce Gap."'' AAMC Reporter: April 2005. [http://www.aamc.org/newsroom/reporter/april05/word.htm]</ref> and involved "strong efforts" by medical organizations to discredit [[Doctor of Osteopathic medicine|osteopathic]] medicine.<ref name = "Cecil">''Chapter 34: Complementary and Alternative Medicine.'' Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004.</ref> Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a [[cult]] and osteopaths were seen as "cultist." The AMA code of ethics declared it unethical for a medical physician to voluntarily associate with an osteopath.<ref name="NYT">Zuger A. ''Scorned No More, Osteopathy Is on the Rise.'' New York Times. 17 February 1998.</ref><ref name="Military">{{cite pmid|9615560}}</ref>
{{Quote box
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| align = right
| quote = To ask a doctor's opinion of osteopathy is equivalent to going to Satan for information about Christianity."
| source = [[Mark Twain]], 1901 
}}
One notable advocate for the fledgling movement was [[Mark Twain]]. Manipulative treatments had purportedly alleviated the symptoms of his daughter [[Jean Clemens|Jean's]] [[epilepsy]] as well as Twain's own [[chronic bronchitis]]. In 1909, he spoke before the [[New York State Assembly]] at a hearing regarding the practice of osteopathy in the state. "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven't been able to sleep." Philosophically opposed to the [[American Medical Association]]'s stance that its own type of medical practice was the only legitimate one, he spoke in favor of licensing for osteopaths. Physicians from the [[New York County Medical Society]] responded with a vigorous attack on Twain, who retorted with "[t]he physicians think they are moved by regard for the best interests of the public. Isn't there a little touch of self-interest back of it all?" "...&nbsp;The objection is, people are curing people without a license and you are afraid it will bust up business."<ref name="Twain">{{cite pmid|9005751}}</ref> 

{| class="infobox" cellpadding="4" style="font-size: 105%; align="left;""
|-
|align=center colspan=2|'''Evolution of osteopathic medicine's mission and identity'''<ref name="Reform"/>
|-
|bgcolor="#ccbcff" align=center|'''Years'''
|bgcolor="#ccbcff" align=center colspan=2|'''Identity & Mission'''
|-
|bgcolor="#ccccff" align=center| 1892 to 1950
|bgcolor="#ccccff" align=center| Manual medicine
|-
|bgcolor="#ccdcff" align=center| 1951 to 1970
|bgcolor="#ccdcff" align=center| Family practice / manual therapy
|-
|bgcolor="#ccecff" align=center| 1971 to present
|bgcolor="#ccecff" align=center| Full service care / multispeciality orientation
|}

===1916-1966, Federal recognition===
Recognition by the [[Federal government of the United States|US federal government]] was a key goal of the osteopathic medical profession in its effort to establish equivalency with its MD counterparts. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the [[Army Medical Department (United States)|US Military Medical Corps]]. On May 3, 1966 [[United States Secretary of Defense|Secretary of Defense]] [[Robert McNamara]] authorized the acceptance of DO's into all the medical military services on the same basis as MD's. The first DO to take the oath of office to serve as a military physician was Harry J. Walter. The acceptance of osteopathic physicians was further solidified in 1996 when [[Ronald R. Blanck|Ronald Blanck, DO]] was appointed to serve as [[Surgeon General of the United States Army|Surgeon General of the Army]], the only osteopathic physician to hold the post.<ref name="Military"/>

===1962, California===
{{Main|Osteopathic Physicians and Surgeons of California v. California Medical Association}}
In the 1960s in [[California]], the [[American Medical Association]] (AMA), sensing increased competition from osteopathic medicine, spent nearly [[Dollar|$]]8&nbsp;million to end the practice of osteopathic medicine in the state. In 1962, Proposition 22, a statewide ballot initiative in [[California]], eliminated the practice of osteopathic medicine in the state. The California Medical Association (CMA) issued [[Doctor of Medicine|MD]] degrees to all [[DO]]s in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (DO) could obtain an MD degree; 86 percent of the DO's in the state (out of a total of about 2000) chose to do so."<ref name = "Paradox">{{cite pmid|10547412}}</ref> Immediately following, the AMA re-accredited the formerly-osteopathic University of California at Irvine College of Osteopathic Medicine as [[University of California, Irvine School of Medicine]], an MD medical school. It also placed a ban on issuing physician licenses to DO's moving to California from other states.<ref name="The DO's">[[Norman Gevitz|Gevitz N.]] ''The DO's: osteopathic medicine in America''. Baltimore: [[Johns Hopkins University]] Press, 1982.</ref> However, the decision proved to be controversial. In 1974, after protest and lobbying by influential and prominent DO's, the [[California Supreme Court]] ruled in [[Osteopathic Physicians and Surgeons of California v. California Medical Association]], that licensing of DO's in that state must be resumed.

===1969, AMA House of Delegates approval===
[[Image:DO residents in ACGME total.jpg|thumb|290px|Total number of DO's in [[Residency_(medicine)#United_States|residency programs]], by year.{{legend|#5B8CBE|DO residents in ACGME (MD) programs<ref>{{cite pmid|16145028}}</ref>}}
{{legend|#BE5B5B|DO residents in AOA (DO) programs.<ref>Stephen C. Shannon. [http://www.aamc.org/workforce/pwrc06/shannon.pdf ''The Impact of Osteopathic Medicine’s Growth on Physician Workforce.''] AAMC</ref>}}]]
In 1969, the American Medical Association (AMA) approved a measure allowing qualified osteopathic physicians as full and active members of the Association. The measure also allowed osteopathic physicians to participate in AMA-approved intern and [[Residency_(medicine)#United_States|residency programs]]. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur, MD sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of DO and MD professions.  Today, a majority of osteopathic physicians are trained alongside MDs, in residency programs governed by the [[ACGME]], an independent board of the AMA.<ref name="ACGME">{{cite pmid|15176520}}</ref>

=== Non-discrimination policies ===
Recent years have seen a professional rapprochement between the two groups. DO's have been admitted to full active membership in the [[American Medical Association]] since 1969. The AMA has invited a representative of the American Osteopathic Association to sit as a voting member in the AMA legislative body, the house of delegates.<ref name="ACP">Wilson, Jennifer Fisher. [http://www.acponline.org/journals/news/nov97/osteopat.htm Osteopathic medicine's growing pains]. [[American College of Physicians]] Observer. November 1997.</ref>

==== 2006, American Medical Student Association ====
In 2006, during the presidency of an osteopathic medical student, the [[American Medical Student Association]] (AMSA) adopted a policy regarding the membership rights of osteopathic medical students in their main policy document, the "Preamble, Purposes and Principles."
{{quotation|AMSA RECOGNIZES the equality of osteopathic and allopathic medical degrees within the organization and the healthcare community as a whole. As such, DO students shall be entitled to the same opportunities and membership rights as allopathic students.|''PPP'', AMSA<ref name = "AMSA">[http://www.amsa.org/about/ppp/osteo.cfm ''Principles Regarding Osteopathic Medicine.''] Preamble, Purposes and Principles. [[American Medical Student Association]].</ref>}}

==== 2007, AMA ====
In recent years, the largest MD organization in the US, the [[American Medical Association]], adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an MD or DO medical school.<ref name="ama295">[http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-295.876.HTM AMA policy H-295.876]</ref> 

In 2006, calls for an investigation into the existence of differential fees charged for visiting osteopathic and MD medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting DO and MD medical students at MD medical schools, it was found that one institution of the 102 surveyed charged different fees for DO and MD students.<ref>Thomas MK (presenter). [http://www.ama-assn.org/ama1/pub/upload/mm/467/cme6a07.doc Recommendation on Equal Fees for Osteopathic and Allopathic Medical Students.] Council on Medical Education, American Medical Association. Report 6-A-07.</ref> The house of delegates of the [[American Medical Association]] adopted resolution 809, I-05 in 2007.
{{quotation|Our AMA, in collaboration with the American Osteopathic Association, discourages discrimination against medical students by institutions and programs based on osteopathic or allopathic training.|AMA policy H-295.876<ref name="ama295"/>}}

[[Image:DO states practice rights.PNG|thumb|left|320px|Years in which states passed laws granting DO's medical practice rights equal to MDs<br /> {{legend0|#9E9EFF|1901-1930 }} {{legend0|#0080FF|1931-1966 }} {{legend0|#80FFFF|1967-1989}}]]

===State licensing of practice rights===
In the United States, laws regulating physician licenses are governed by the states. Between 1901 to 1989, osteopathic physicians lobbied state legislatures to pass laws giving those with a DO degree the same legal privilege to practice medicine as those with an MD degree. In many states, the debate was long and protracted.  Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was [[California]] in 1901, the last was [[Nebraska]] in 1989.<ref name="The DO's"/>

{{-}}

==Current status==
{| class="infobox" cellpadding="0" style="font-size: 90%; align="left;" width:20%"
|-
|align=center colspan=3|'''Osteopathic medical schools''' 
|-
|align=center|Region
|align=center|School
|align=center|Website
|-
|bgcolor="#ccbcff" align=center valign=center rowspan=7|Midwest <br />& Plains
|bgcolor="#ccbcff" style="font-size: 80%;" align=center|[[A. T. Still University|AT Still Kirksville]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.atsu.edu/kcom/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Des Moines University|Des Moines COM]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.dmu.edu/com/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Kansas City University of Medicine and Biosciences|Kansas City COM]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.kcumb.edu/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Michigan State University College of Osteopathic Medicine|Michigan State]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.com.msu.edu/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Midwestern University|Midwestern Chicago]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.midwestern.edu/ccom/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Ohio University|Ohio COM]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.oucom.ohiou.edu/]
|-
|bgcolor="#ccbcff" style="font-size: 80%;" align=center| [[Oklahoma State University - Center for Health Sciences|Oklahoma State]]
|bgcolor="#ccbcff" align=center style="font-size: 80%;" valign=center| [http://www.healthsciences.okstate.edu/]
|-
|bgcolor="#ccccff" align=center rowspan=6| Northeast
|bgcolor="#ccccff" style="font-size: 80%;" align=center| [[Lake Erie College of Osteopathic Medicine|Lake Erie COM]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://www.lecom.edu/]
|-
|bgcolor="#ccccff" style="font-size: 80%;" align=center|[[University of New England, Maine|New England COM]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://www.une.edu/com/]
|-
|bgcolor="#ccccff" style="font-size: 80%;" align=center| [[New York College of Osteopathic Medicine|New York COM]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://iris.nyit.edu/nycom/]
|-
|bgcolor="#ccccff" style="font-size: 80%;" align=center| [[Philadelphia College of Osteopathic Medicine|Philadelphia COM]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://www.pcom.edu/]
|-
|bgcolor="#ccccff" style="font-size: 80%;" align=center|[[Touro College of Osteopathic Medicine|Touro Harlem]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://www.touro.edu/med/]
|-
|bgcolor="#ccccff" style="font-size: 80%;" align=center| [[School of Osteopathic Medicine (UMDNJ)|UMDNJ-SOM]]
|bgcolor="#ccccff" align=center style="font-size: 80%;" valign=center| [http://som.umdnj.edu/]
|-
|bgcolor="#ccdcff" align=center rowspan=9| Southeast
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Lake Erie College of Osteopathic Medicine|Lake Erie COM Bradenton]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.lecom.edu/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Lincoln Memorial University|Lincoln Memorial]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.lmunet.edu/dcom/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[University of North Texas Health Science Center at Fort Worth|North Texas COM]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.hsc.unt.edu/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Nova Southeastern University College of Osteopathic Medicine|Nova Southeastern]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://medicine.nova.edu/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Philadelphia College of Osteopathic Medicine|Philadelphia COM Georgia]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.pcom.edu/General_Information/georgia/georgia.html]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Pikeville College|Pikeville SOM]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://pcsom.pc.edu/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[Virginia College of Osteopathic Medicine|Virginia COM]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.vcom.vt.edu/]
|- 
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[West Virginia School of Osteopathic Medicine|West Virginia SOM]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.wvsom.edu]
|-
|bgcolor="#ccdcff" style="font-size: 80%;" align=center| [[William Carey University|William Carey COM]]
|bgcolor="#ccdcff" align=center style="font-size: 80%;" valign=center| [http://www.wmcarey.edu/]
|-
|bgcolor="#ccecff" align=center rowspan=7| West
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[A. T. Still University|AT Still Arizona]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.atsu.edu/soma/]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Midwestern University|Midwestern Arizona]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.midwestern.edu/azcom/]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Pacific Northwest University of Health Sciences|Pacific Northwest]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.pnwu.org/]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Rocky Vista University College of Osteopathic Medicine|Rocky Vista]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.rockyvistauniversity.org/]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Touro University California|Touro California]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.tu.edu/departments.php?id=43]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Touro University Nevada|Touro Nevada]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.tu.edu/departments.php?id=44]
|-
|bgcolor="#ccecff" align=center style="font-size: 80%;" align=center| [[Western University of Health Sciences|Western]]
|bgcolor="#ccecff" align=center style="font-size: 80%;" valign=center| [http://www.westernu.edu/xp/edu/comp/recruitment.xml]
|}
=== Education and training ===
{{Main|Medical school in the United States|Medical education in the United States}}
According to [[Harrison's Principles of Internal Medicine]], "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic [[Doctor of Medicine|MD]] physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification."<ref name = "Harrisons"/>

DO-granting US medical schools have [[curricula]] identical for the most part to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine.
====Graduate medical education====
[[Image:NewDocsTraining.PNG|thumb|left|390px|Sources of the 24,012 medical school graduates entering US physician training programs in 2004.<ref name="Shannon">Shannon, Stephen C. [http://www.aamc.org/workforce/pwrc06/shannon.pdf ''The Impact of Osteopathic Medicine’s Growth on Physician Workforce in the US''] [[American Association of Colleges of Osteopathic Medicine|AACOM]]. accessed Feb 2007.</ref>]]Upon graduation, most osteopathic medical physician pursue [[residency (medicine)|residency]] training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating [[internship (medicine)|internship]] at a hospital approved by the [[American Osteopathic Association]] (AOA).
Osteopathic physicians may apply to residency programs accredited by either the AOA or the [[Accreditation Council for Graduate Medical Education]] (ACGME). Currently, osteopathic physicians participate in more ACGME programs than in programs approved by the American Osteopathic Association (AOA).<ref name="ACGME"/>
{{further|[[Comparison of MD and DO in the United States]]}}

=== Osteopathic Manipulative Treatment (OMT)===
{{Main|Osteopathic manipulative medicine}}
Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. However, a 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like MD physicians in every respect — few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment.<ref>{{cite pmid|11500286}}</ref> 
[[Image:Manuellterapi5.jpg|left|450px|thumb|[[Osteopathic manipulative treatment]] (OMT) involves [[palpation]] and [[joint manipulation|manipulation]] of [[bone]]s, [[muscle]]s, [[joint]]s, and [[fascia]]e.]]The [[American Osteopathic Association]] has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation as well as to encourage DO's to consistently offer manipulative treatments to their patients. However, the number of DO's who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist [[Norman Gevitz]]<ref name="NYT"/> cites poor educational quarters and few full-time OMM instructors as major factors for the decreasing interest of medical students in OMM. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction," and he claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students.<ref name = "Gevitz">{{cite pmid|16585378}}</ref>

{{cquote|In their assigned readings, students learn what certain prominent DO's have to say about various somatic dysfunctions. There is often a theory or model presented that provides conjectures and putative explanations about why somatic dysfunction exists and what its significance is. Instructors spend the bulk of their time demonstrating osteopathic manipulative (OM) techniques without providing evidence that the techniques are significant and efficacious. Even worse, faculty members rarely provide instrument-based objective evidence that somatic dysfunction is present in the first place.<ref name = "Gevitz" />|30px|30px}}

At the same time, recent studies show an increasingly positive attitude of patients and physicians (MD and DO) towards the use of manual therapy as a valid, safe and effective treatment modality.<ref name = "pmid11837337">{{cite pmid|11837337}}</ref> One survey, published in the Journal of [[Continuing Medical Education]], found that a majority of physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe, and over half (56% of physicians and 59% of patients) felt that manipulation should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM.<ref>{{cite pmid|12739255}}</ref> Another small study examined the interest and ability of MD residents in learning osteopathic principles and skills, including OMM. It showed that after a 1-month elective rotation, the MD residents responded favorably to the experience.<ref>{{cite pmid|16273444}}</ref>

=== Professional attitudes ===
Recent years have seen an increasingly cooperative climate between the DO and MD professions.
In 1998, a New York Times article described the increasing numbers, public awareness, and mainstreaming of osteopathic physicians, but said that "some aspects of osteopathic practice can still raise eyebrows among conventional doctors." "Leaders of conventional medicine may no longer use the word ''quack,'' but many still look askance at the osteopathic system of medical thought, which they feel lacks the intellectual rigor and the scientific underpinnings of their own practice."<ref name="NYT">Zuger A. ''Scorned No More, Osteopathy Is on the Rise.'' New York Times. 17 Feb 1998.</ref> 

In 2005, during his tenure as president of the [[American Association of Medical Colleges]], Jordan Cohen described a climate of cooperation between DO and MD practitioners. {{cquote|We now find ourselves living at a time when osteopathic and allopathic graduates are both sought after by many of the same residency programs; are in most instances both licensed by the same licensing boards; are both privileged by many of the same hospitals; and are found in appreciable numbers on the faculties of each other's medical schools.<ref name="Cohen"/>|30px|30px}} Elsewhere, he has remarked that [[Osteopathic manipulative medicine|osteopathic manipulative medicine (OMM)]] can be an aid to the physician in fostering a relationship with the patient, while also a source of skepticism to MDs. In particular, he noted that suggestions that OMM could be used to treat diseases other than back problems, "reinforces lingering feelings among proponents of conventional medicine that osteopathy is simply a less intellectual field all around."<ref name="NYT"/>

===International practice rights===
[[Image:DOworld.PNG|thumb|450px|right|International practice rights of US trained DO's {{legend|#319931|Practice rights generally recognized as equal to U.S.-M.D.s}}
{{legend|#A9A964|Unlimited practice rights granted, but difficult to obtain}}
{{legend|#6C0000|Limited to manipulation-only}}
{{legend|#C0C0C0|Unknown or previously denied}}]]

Each country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the [[United States Department of Education|US Department of Education]] recognizes as physicians are graduates of [[List of medical schools in the United States|osteopathic medical colleges in the United States]].<ref>[http://www.ed.gov/legislation/FedRegister/other/2005-4/100305b.pdf ''Notices.''] Federal Register. Vol. 70, No. 190. 3 Oct 2005.</ref> Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained DO's are currently able to practice in 45 countries with full medical rights and in several others with restricted rights.

The ''Bureau on International Osteopathic Medical Education and Affairs'' (BIOMEA) is an independent board of the [[American Osteopathic Association]]. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained DO's. Towards this end, the BIOMEA works with international health organizations like the [[World Health Organization]] (WHO), the [[Pan American Health Organization]] (PAHO) as well as other groups.<ref>[https://www.do-online.org/index.cfm?PageID=lcl_main&au=A&SubPageID=lcl_interntnl  ''International.'' American Osteopathic Association. DO-online.org]</ref>

The procedure by which international countries consider granting physician licensure to foreigners varies widely. For US trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, [[Doctor of Medicine|MD]] or [[Doctor of Osteopathic medicine|DO]]<ref name = "Int'l table">''AOA International License Summary.'' [[American Osteopathic Association]]. Council on International Osteopathic Medical Education and Affairs.[http://www.tugsa.net/InternationalDO.pdf]</ref> Many countries recognize US-trained MDs as applicants for licensure, granting successful applicants "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained DO's similarly to their MD counterparts, with some success.{{Osteopathic medicine2}} In 44 countries, US-trained DO's have unlimited practice rights. In 2005, after one year of deliberations, the [[General Medical Council of Great Britain]] announced that US-trained DO's will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an [[osteopathic physician]] and an [[osteopath]]."<ref>''DO's around the World.'' [[American Osteopathic Association]].[http://www.osteopathic.org/index.cfm?PageID=ost_dogoblobal]</ref> The [[American Medical Student Association]] strongly advocates for US-trained DO international practice rights "equal to that" of MD qualified physicians.<ref name = "AMSA"/>{{-}}

===Osteopathic medicine and primary care ===
[[Image:OsteoPrimaryCare.PNG|thumb|left|400px|Trends in primary care as a career choice of osteopathic medical students<ref name="Singer">Singer, Allen M. [http://www.aacom.org/resources/bookstore/debt/Pages/default.aspx Debt, Plans and Opinions of Osteopathic Medical Students in 2004.] American Association of Colleges of Osteopathic Medicine.</ref><br />{{legend0|#4A75AD|4th year students   }}  {{legend0|#9CAED6|1st year students }}]]

<br />
<br />
Osteopathic physicians have historically entered [[primary care]] fields at a higher rate than their MD counterparts. Some osteopathic organizations make claims to a greater emphasis on the importance of primary care within osteopathic medicine. However, the proportion of osteopathic students choosing primary care fields, like that of their MD peers, is declining.<ref name="pmid15980090">{{cite pmid|15980090}}</ref> Currently, only one in five osteopathic medical students enters a [[family medicine]] residency (the largest primary care field).<ref>{{cite pmid|16127950}}</ref> In 2004, only 32% of osteopathic seniors planned careers in any primary care field; this percentage was down from a peak in 1996 of more than 50%.<ref name="Singer">Singer, Allen M [http://www.aacom.org/resources/bookstore/debt/Pages/default.aspx Debt, Plans and Opinions of Osteopathic Medical Students in 2004.] American Association of Colleges of Osteopathic Medicine.</ref>{{-}}

== Criticism and internal debate==
===OMM===
Traditional osteopathic medicine, specifically [[Osteopathic manipulative medicine|OMM]], has been criticized for many techniques such as [[craniosacral therapy|cranial and cranio-sacral manipulation]]. A recent study questions the therapeutic utility of osteopathic manipulative treatment modalities.<ref>Heath D, Gevitz N. The research status of somatic dysfunction. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1188–1193.</ref> A website cites numerous studies demonstrating that there are some ailments for which the benefit of manipulative therapy has "firmly established" scientific support.<ref name = "Harvard">[http://www.intelihealth.com/IH/ihtIH?d=dmtContent&c=358839&p=~br,IHW|~st,8513|~r,WSIHW000|~b,*  ''Osteopathic Medicine.''] Intelihealth.com.</ref> Also, [[New York University]] health information website claims that "it is difficult to properly ascertain the effectiveness of a hands-on therapy like OM."<ref>[http://www.med.nyu.edu/patientcare/library/article.html?ChunkIID=37409#evidence ''What Is the Scientific Evidence for Osteopathic Manipulation?''] [[New York University School of Medicine|NYU Medical Center]].</ref>

===Research emphasis===
Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at DO schools in comparison with MD schools.<ref name="pmid11329813">{{cite pmid|11329813}}</ref><ref>Kelso A, Townsend A. The status and future of osteopathic research. In: Northup G, ed. Osteopathic Research: Growth and Development. Chicago, Ill: American Osteopathic Association; 1987.</ref><ref name="Licciardone, John C., Osteopathic research: elephants, enigmas, and evidence">{{cite journal |author=Licciardone, John C. |title=Osteopathic research: elephants, enigmas, and evidence |journal=Osteopathic Medicine and Primary Care 2007, 1:7 |year=2007 |url=http://www.osteopath-help.co.uk/osteopaths/cranial-osteopathy/downloads/osteopathic_research_-_elephants,_enigmas_and_evidence.pdf |format=PDF}}</ref> {{cquote|The inability to institutionalize research, particularly clinical research, at osteopathic institutions has, over the years, weakened the acculturation, socialization, and distinctive beliefs and practices of osteopathic students and graduates.<ref name="pmid11329813"/>|30px|30px}}

===Identity crisis===
There is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care.<ref name = "Reform">{{cite pmid|8267703}}</ref><ref name = "Parallel">{{cite pmid|8027001}}</ref><ref name = "Gevitz">{{cite pmid|16585378}}</ref><ref>Teitelbaum HS, Bunn WE, Brown SA, Burchett AW. [http://www.jaoa.org/cgi/reprint/103/10/489.pdf ''Osteopathic Medical Education: Renaissance or Rhetoric?''] J Am Osteopath Assoc. Vol 103;No 10 October 2003.</ref><ref>Tatum, William O, IV. [http://www.jaoa.org/cgi/content/full/106/8/442 ''AOA Needs to Reach Out More.''] J Am Osteopath Assoc. Vol 106 No 8 p442-443. August 2006.</ref><ref name = "Last DO">{{cite pmid|16717365}}</ref><ref>{{cite pmid|16717364}}</ref><ref>{{cite pmid|16790537}}</ref><ref name = "Future1">Shannon, Stephen C. ''[http://www.aacom.org/resources/ome/Pages/default.aspx What Does the Future Hold?]'' Inside Osteopathic Medical Education. Vol 2 No 1 February 2008. p1.</ref>  JD Howell, author of ''The Paradox of Osteopathy,''<ref name = "Paradox" /> notes claims of a "fundamental yet ineffable difference" between MD and DO qualified physicians are based on practices such as "preventive medicine and seeing patients in a sociological context" that are "widely encountered not only in osteopathic medicine but also in allopathic medicine."<ref>Howell, J D [http://content.nejm.org/cgi/content/full/342/11/817 ''Correspondence.''] New Engl J Med. Volume 342:817-820 Number 11. 16 March 2000.</ref> Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD<ref>{{cite pmid|12409127}}</ref><ref>{{cite pmid|17371578}}</ref> Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:
[[Image:1styear osteopathic enrollment.PNG|thumb|right|330px|First-year enrollment at osteopathic medical schools, 1968-2007]]
{{cquote|If osteopathy has become the functional equivalent of allopathy [meaning the MD profession], what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic, why should its use be limited to osteopaths?<ref name = "Paradox">{{cite pmid|10547412}}</ref>|30px|30px}}
====Rapid expansion====
As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.
{{cquote|within the osteopathic community, the growth is drawing attention to the identity crisis faced by [the profession]. While osteopathic leaders emphasize osteopaths' unique identity, many osteopaths would rather not draw attention to their uniqueness.<ref name="ACP"/>|30px}}

The rapid expansion has raised concerns about the number of available faculty at osteopathic schools and the role those faculty play in maintaining the itegrity of the academic program of the schools.  [[Norman Gevitz]], author of the leading text on the history of ostoepathic medicine, recently published, 

{{cquote|DO schools are currently expanding their class sizes much more quickly than are their MD counterparts. Unlike MD colleges, where it is widely known that academic faculty members—fearing dilution of quality as well as the prospect of an increased teaching workload—constitute a powerful inhibiting force to expand class size, osteopathic faculty at private osteopathic schools have traditionally had little or no input on such matters. Instead, these decisions are almost exclusively the responsibility of college administrators and their boards of trustees, who look at such expansion from an entrepreneurial as well as an educational perspective. Osteopathic medical schools can keep the cost of student body expansion relatively low compared with that of MD institutions. Although the standards of the Commission on Osteopathic College Accreditation ensure that there will be enough desks and lab spaces to accommodate all new students, they do not mandate that an osteopathic college must bear the expense of maintaining a high full-time-faculty:student ratio.<ref name = "faculty">{{Cite pmid|19474540}}</ref>|30px}}

The president of the American Association of Colleges of Osteopathic Medicine commented on the current climate of crisis within the profession.  {{cquote|The simultaneous movement away from osteopathic medicine’s traditionally separate training and practice systems, when coupled with its rapid growth, has created a sense of crisis as to its future. The rapid rate of growth has raised questions as to the availability of clinical and basic science faculty and clinical resources to accommodate the increasing load of students.<ref name ="Shannon2">{{Cite pmid|19474542}}</ref>|30px}}

===For-profit medical education===
The accreditation of [[RVUCOM]] generated some controversy before the school held its first class. Like all osteopathic medical schools, RVUCOM is accredited by a board of the [[American Osteopathic Association]] (AOA) Commission on Osteopathic College Accreditation (COCA). Unlike the other 28 osteopathic and 126 [[Medical Doctor|MD]] medical colleges in the US, RVUCOM is organized as a [[for-profit school|for-profit]] corporation.<ref name = "RVU">Croasdale, Myrle. [http://www.ama-assn.org/amednews/2007/10/01/prsc1001.htm ''First for-profit med school nears approval'']. American Medical News. 1 Oct 2007.</ref> Critics claimed the AOA's approval of a for-profit school "erodes creditability" of osteopathic medical schools, especially in comparison to their MD counterparts.<ref>{{cite pmid|17682109}}</ref>
The [[Liaison Committee on Medical Education]], which accredits the MD-granting US medical schools, has banned for-profit schools.<ref>Mychaskiw G. [http://www.tugsa.net/Mychaski1910AllOverAgain.pdf ''Future of DO.''] powerpoint presentation. accessed 7 Nov 2007.</ref> School officials insist the for-profit status of the school will not compromise the integrity of its educational mission.<ref>Martin RB. [http://www.jaoa.org/cgi/content/full/107/10/426 ''RVUCOM: Striving to Meet the Needs of the Osteopathic Medical Profession''] J Am Osteopath Assoc. 2007 Oct;107(10):426-8. PMID 17956994</ref> 2007-2008 AOA president and orthopedic surgeon Peter Ajluni, D.O. responded, "there are many socially minded for-profit companies that contribute time, resources, and profits to their communities" and "for-profit institutions like RVUCOM can further the cause of osteopathic medicine in the United States."<ref>{{cite pmid|17956993}}</ref>

== References ==
{{Reflist|colwidth=30em}}

== Further reading ==
*<cite>The DO's: Osteopathic Medicine in America</cite>, [[Norman Gevitz]], 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0-8018-7834-9 (''An excellent review of the history and development of ostepathic medicine and medical education in the United States'')
*<cite>Science in the Art of Osteopathy: Osteopathic Principles and Models</cite>, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
*<cite>An Osteopathic Approach to Diagnosis and Treatment </cite>, Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5
{{Medical education in the United States}}
{{Osteopathic medical schools}}
{{Medicine}}

{{DEFAULTSORT:Osteopathic Medicine In The United States}}
[[Category:Manipulative therapy]]
[[Category:Osteopathy]]
[[Category:Osteopathic medicine]]
[[Category:Medical education in the United States]]
[[Category:Medical and health organizations based in the United States]]
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[[Category:2Fix]]